MBC Ch 16 & 17 Billing & Insurance

Guidelines for claims submission, such as which services are covered, and reimbursement rates is dictated by:

• the insurance company

• the healthcare provider

• the insured

• the insured's employer

If an insured is in disagreement with the insurer for settlement of a claim, a suit must begin within:

• 1 year

• 2 years

• 3 years

• 5 years

If the insurance billing specialist posts a payment and there is a remaining balance, they should always:

• send an appeal to the insurance company for the balance

• write off the remaining balance

• bill the patient for the balance

• determine the appropriate course of action

Delinquent claims are claims that have not been paid:

• within 15 days of the service date

• within 13-30 days of the service date

• within 30-45 days of the service date

• within 45-60 days of the service date

If an insurance claim appears to have been lost, the procedure(s) to follow is to:

• contact the insurance company to check the claim status

• submit a copy of the original claim

• verify the correct mailing address

• All are correct.

An insurance claim for a service that has been bundled with other services would be:

• paid

• rejected

• suspended

• denied

A submitted claim that does not follow specific third-party payer instructions or contains a technical error is referred to as

• paid.

• rejected.

• suspended.

• denied.

Medical services which are performed primarily for the convenience of the patient or the health care provider would be denied as:

• an invalid service

• a nonspecific service

• not medically necessary

• a bundled procedure

A request for a Medicare administrative law judge hearing can be made if the amount in controversy is at least

• $170.

• $250.

• $350.

• $500.

Cash flow is

• the amount of money available in the cash drawer.

• the amount of money taken into the office in a given period of time.

• the ongoing availability of cash in the medical practice.

• the amount of money in accounts receivable.